Murphy Road Animal Hospital / Training Application Form

Form - Training Application Form

Please select the class for which you are registering (required)
Puppy Preschool

Name (required)
First Name (required)	Last Name (required)

Address (required)
Street Address (required)


City (required)	State/Province (required)	Zip/Postal Code (required)
,

Phone (required)
Phone Type	Phone Number (required)

Phone (required)
Phone Type	Phone Number (required)

E-Mail Address (required) :

Dog's Information

Dog's Name (required)

Breed (required)

Age (required)

Weight (required)

Sex (required)
M
F

Health and Temperament Agreement

I hereby certify that my dog(s) (required)
are in good health
have not been ill with any communicable diseases in the last 21 days
has not harmed or shown aggressive behavior toward any person or any other dog.

VACCINATION DATES:

DHPP(Distemper,Hepatitis,Parainfluenza,Parvovirus)

Given by:

RABIES

Given by:

BORDATELLA

Given by:

FECAL SAMPLE

Tested by:

Is your dog on flea and/or tick prevention? A flea check may be performed at the first class. (required)
yes
no

If yes, what kind?

Is your dog on heartworm pills? (required)
yes
no

If yes, what kind?

Is this your first dog to own? If not, how many have you owned before?

Is this your first dog to attend an obedience training class with?

Do you have more than one dog currently in your home? If yes, please list sizes and what ages?

What percentage of time is your dog outside?

Does your dog sleep inside your house or outside?

Is someone at home during the day with your dog? If not, how many hours is the dog at home alone?

How would you describe the personality of your dog (playful, dominate, lazy, curious, etc.)?

What are your goals for your dog in general?

What would you like to accomplish with your dog's completion of this class?

Release: (required)
I release Murphy Road Animal Hospital from any and all liability if my dog or I should become ill or injured during training.

Signature of Owner (required)

Date (required)

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